Annals for Educators - August 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesAugust 2023Annals for Educators - August 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202308150 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsAssociation Between Age and Low-Density Lipoprotein Cholesterol Response to Statins. A Danish Nationwide Cohort StudyRecommendations for statin use for primary or secondary prevention are based on studies that underrepresented persons older than 75 years. This Danish national register–based cohort study compares the low-density lipoprotein cholesterol response to different-intensity statin use in older versus younger persons.Use this article to:Review the indications for use of statins. This In the Clinic review can help guide the discussion. Discuss the strengths and weaknesses of studies based on registry data.Ask your learners about the factors they would consider when deciding whether to prescribe a statin to a patient who is 80 years old.Fatal Drug Overdose Risks of Health Care Workers in the United States. A Population-Based Cohort StudyDrug overdose deaths have increased in the United States. Health care workers may be at greater risk because of high work-related stress and more ready access to opioids. This nationally representative study examines the risks for drug overdose death among health care workers relative to non–health care workers in the United States.Use this article to:Ask your learners whether they have had a health care worker colleague who suffered from drug use. How has that experience affected them?Invite a clinician from your employee health service to discuss the appropriate actions to take if there is concern about a colleague's substance use.Discuss how to approach a colleague if you are concerned about their substance use.Modernizing the United States' Public Health Infrastructure: A Position Paper From the American College of PhysiciansReflecting on ACP's Position Paper for Public Health: A View From the CDC LensThe U.S. public health sector plays a crucial role in preventing illness and promoting health. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. The authors of the accompanying editorial reflect on the ACP recommendations through the lens of the Centers for Disease Control and Prevention, specifically highlighting budget, workforce, and data issues.Use this article and the editorial to:Initiate a discussion among your learners about the strengths and weaknesses they have observed with the U.S. public health infrastructure.Invite a professional who works with your local public health department to talk with your learners about best practices for interactions between the health department and clinicians and health care institutions.Ask your learners if there are things in addition to what the ACP recommends that would strengthen the U.S. public health infrastructure.Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians (Version 2)New American College of Physicians Guidance on Colorectal Cancer Screening: Less Is MoreThis updated ACP guidance statement on screening for colorectal cancer provides guidance on the ages at which to start and stop screening and on selection of the type and frequency of screening tests in asymptomatic, average-risk adults. The accompanying editorial discusses the differences between the ACP recommendations and those of the U.S. Preventive Services Task Force and the American Cancer Society.Use this article and the editorial to:Ask your learners how they would advise a relative who was at average risk for colorectal cancer who asked about when to begin screening.Discuss the potential benefits and harms of expanding screening recommendations to younger ages.Radiology organizations took issue with the ACP's recommendation against using CT colonoscopy to screen for colorectal cancer. Discuss the rationale behind ACP's recommendation.Beyond the GuidelinesHow Would You Manage This Patient With Clostridioides difficile Infection? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterRecent updated guidelines from the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and the American College of Gastroenterology on management of patients with Clostridioides difficile infection generally agree but make slightly different recommendations about antibiotic treatment options for nonsevere disease, the role of fecal microbiota transplantation for fulminant disease, and the use of bezlotoxumab to prevent recurrence. In this article, an infectious diseases specialist and a gastroenterologist discuss a patient case and their approach to the many treatment options that are available.Use this article to:Watch the patient video with your learners and then ask them what they would recommend for this patient with C difficile infection.Discuss the availability of fecal microbiota transplantation at your institution and the process for referring a patient who might benefit from it.Watch the grand rounds video with your learners and then have them test their knowledge by completing the quiz that accompanies the article.Medicine and Public IssuesMoving Naloxone Over the Counter Is Necessary but Not SufficientAlthough naloxone has a crucial role in stemming the loss of life in the opioid overdose crisis in the United States, it remains largely inaccessible to the public. This article argues that making naloxone available over the counter would be crucial in making full use of its lifesaving capacity but that other policy efforts are also needed to maximize its use and reduce overdose deaths.Use this article to:Invite a pharmacist or an emergency medicine clinician to your session to demonstrate the correct way to administer naloxone.Discuss how naloxone is currently made available in your state.Ask your learners to brainstorm about what might be done beyond the recommendations in this commentary to expand access to and use of naloxone and reduce opioid overdose death.Addressing Viral Medical Rumors and False or Misleading InformationThe rapid spread of medical rumors and false or misleading medical information on social media is a vexing challenge that threatens health. Understanding the information ecosystem can provide critical insights for strong coordination between stakeholders and funders to counter this threat. This article describes the efforts of ThisIsOurShot and VacunateYa to spread accurate health information about COVID-19 and COVID-19 vaccines and discusses the lessons that have been learned. The authors provide recommendations for future coordinated efforts to counter the digital spread of medical rumors, misinformation, and disinformation.Use this article to:Ask your learners to share their experiences of encountering patients who have been influenced by misleading health information spread via social media.Review the definitions of misinformation, disinformation, and viral rumors provided in the article.Discuss whether your learners think that the strategies for counteracting these various types of misleading information should be different.As a group, search Google for information about COVID-19 vaccines. Do the sources shown at the top of the search appear to be credible? What factors drive judgments about credibility?Ask your learners to brainstorm about what might be done beyond the recommendations in this article to reduce the spread of misleading health information on social media.ContraceptionContraception counseling and provision are vital components of comprehensive health care. An unplanned pregnancy can be particularly challenging for patients with chronic illness. Internal medicine physicians are in a unique position to assess pregnancy readiness and provide contraception, as they often intersect with pregnancy-capable patients at the moment of a new diagnosis or when providing ongoing care for a chronic medical condition. A shared decision-making counseling approach engages patients, ensures patient-centered care, and supports their choice of a contraceptive method that aligns with their reproductive plans and medical needs.Use this article to:Review the available options for contraception and how to choose from among them.Ask your learners to list contraindications to use of hormonal contraceptives.Invite a gynecologist to your session to review the options for long-acting contraception and the process for referring patients if these options are not available in the primary care setting.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.ACP AnnouncementHerbert S. Waxman Chief Resident Teaching ScholarshipChief residents who are members of ACP are eligible to apply for a Herbert S. Waxman Chief Resident Teaching Scholarship. Waxman Scholars assist in teaching popular workshops under the guidance and mentorship of expert faculty in the Clinical Skills Center at ACP's Internal Medicine Meeting. The scholarship includes the cost of meeting registration, travel, and accommodations for the 2024 ACP Internal Medicine Meeting, to be held April 18–20 in Boston, Massachusetts. This is an opportunity for chief resident members to build their CVs and gain valuable faculty workshop experience.The submission deadline for applications is September 15, 2023. If you have any questions, please contact ACP. Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics August 2023Volume 176, Issue 8 ePublished: 15 August 2023 Issue Published: August 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...